BSPh, Univ. Texas, Austin, TX, 1936
MHA, Northwestern Univ., Chicago, IL, 1947
Ph.D., Kennedy-Western Univ., 1997
Army War College
Regional Pharmacist, Texas State Dept. Human Services, Austin, TX, 1971-82
Mgr., Hosp. Territory, American Home Products, 1959-71
Program Director, U.S. Army-Baylor Univ., Med. Field Svc. Sch., Ft. Sam Houston, TX, 1947-52
There seems to be a commonality in our psyches that accepts things as they are; and most of us, I suspect, care little of how they got started. But things that exist started with someone's idea. This one such instance of a worthy cause seen to seem to fruition through tenuous circumstances, anyone of which could have doomed it to failure had they not just happened.
The Principal Players.
I. Major General Joseph I. Martin, MC.
General Martin came home from Italy after WWII and VE Day with strong
convictions about Medical Department needs in the fields of education and
training.
Then BG Martin stopped by the Surgeon General's Office on his way to his state-side assignment as Commandant of the Medical Field Service School (MFSS) at Fort Sam Houston, Texas. He voiced his concerns about education and training of Medical Dept personnel to the Surgeon General and his staff. As Surgeon of the Fifth U.S. Army he had seen first hand the needs in the field under combat conditions. His was the voice of experience.
Among his recommendations was that a suitable officer be selected for a degree program in Hospital Administration; this officer was then to be assigned to MFSS to start a program for the Army.
His experiences with medical unit commanders who were physicians trained and educated in the clinical practice of medicine and surgery had convinced him that physicians needed better trained ancillary personnel (middle managers) to relieve them as much as possible of the burdens of "resource management". These trained personnel provide the professional staff with the essential environment in which they could best pursue the ultimate goal of the physician, patient care.
Too often the professionals had to perform their mission housed in tents under field conditions, and there were numerous instances when the bitter cold of the 1943-44 Italian winters found units seeking alternatives to Army tents and Sibley stoves.
Very often an abandoned school building, church or even a ware house gave better protection from the elements than the above mentioned housing components of the unit assembly. Problem was adaptation of rigid physical plant for facilities to patient care needs. Retention of mobility so that "forward" movement could be accomplished in a matter of hours of notice was essential.
American ingenuity and resourcefulness most often saw units 'make the best of it' with great success. Joe Martin, though, realized that what he saw was a need for more education and training in what was than termed "hospital administration" which has been today broadened to "health care administration." He was a visionary of the first order.
II. Hardv Kemp M.D. The Consummate Educator in Medicine.
The Baylor College of Medicine moved from Dallas to Houston sometime around
1930. During the summer months when medical students were on summer break,
faculty members were allowed to "moonlight" by accepting summer
school teaching appointments at other schools.
It was in the summer of 1933 that this writer first encountered Hardy Kemp. He was teaching a course in Immunology at the University of Texas at Austin.
At summer school matriculation a somewhat careless and less- than-knowledgeable faculty advisor had enrolled me in Hardy's class. The advisor, seeing that I had completed one year of pharmacy school, thought a bacteriology course in Immunology would give me elective credits, and that subject appeared germane to my professional education -Good thinking. Trouble was it was a graduate course in bacteriology.
After a few days, Dr. Kemp decided to give a pop exam to see how much we had absorbed from his lectures and laboratory work. Then was when he realized he had a novice student among his graduate bacteriologists! So he counseled me and realized I didn't belong! Instead of 'busting' me on the exam he marked my record 'w/d' and permitted me to gracefully check out without the penalty of a failing grade. After that I didn't see him again for some nine years.
I'll spare the reader of personal detai1s of how I, by sheer accident, became commissioned in the then Medical Administrative Corps.
In about March of 1942 I was Assistant Adjutant to Capt Tom Hester at Walter Reed Army Medical Center. Captain was the top rank achievable to MAC'S of the "old Army", pre-WWII.
One morning I looked up from the paperwork on the desk to find SGT MAJ McAllister with a Major, Medical Corp in tow. It was Hardy Kemp, MAJ, MC, Res. He had been ordered to go to Trinidad to do an island health survey in preparation for sending U.S. Army Air Force troops in to build landing strips and auxiliary facilities for an air base.
MAJ Kemp needed Top Secret clearance and travel orders which we expeditiously supplied and got him on his way
I didn't see Hardy Hemp for another seven years. This prophetic encounter to be later detailed.
III. Major Harry Panhorst. MSC. (An Ardent Reservist).
Harry Panhorst had been a Military Intelligence officer in WWII. In 1949 he had
transferred to the Medical Service Corps and had applied for two weeks of active
duty at the Medical Field Service School which by then had moved to Fort Sam
Houston from Carlisle Barracks, PA.
Harry was at this time Assistant to Frank Bradley, M.D. Director of the Program in Hospital Administration at Washington University in St Louis. He was also assistant administrator of Barnes Hospital, the teaching hospital for the medical school.
Harry's chance assignment to the Department of Administration for his summer training proved to be of great benefit and may well have been critical to the process of affiliating the Army-Baylor programs. His role will be described later.
IV. Dean Wilbur Gooch Ph.D. -The Graduate School Dean, "Par Excellence".
A shock of pure white hair, a soft voice, craggy features, and the fatherly
demeanor of Wilbur Gooch all made him a thoroughly delightful individual with
whom to deal. His role also will be brought into clearer focus later.
V. James T. Richards. Col. MSC. USA (Ret).
Now for my part in the development of what we have today in the Army-Baylor
program. In no way should the reader construe my story to be an attempt at
self-aggrandizement or over embellishment of the role I played in the concept
and development of the program. I use the first person singular only because,
after all, it is my story, and for me to use the third person would appear to
me to be an affectation.
When I returned from the European Theater of Operations, Headquartered in Paris, I had been overseas almost three years from North Africa, through Italy, on through southern France.
In the Theater Surgeon's Office I was given the job of readjusting and redeploying all medical troops out of Europe, embracing some 254,000 troops in medical units scattered from England, Holland, Belgium, France, and Germany. This called for 14 and 15 hour days of work for several months. I mention this only in passing to illustrate the reason for my being burned out, and exhausted by the time of late December of 1945.
Arriving in Washington with my fingers crossed in hopes of being assigned to San Antonio, I paid a visit to Miss Ann Carry. Miss Ann was Secretary to the Chief of Personnel in the Surgeon General's Office and had been in that job so many years until she was relied upon by most people to be the source of greatest knowledge about individuals in the Medical Department. "She knew everyone and all about 'em.
General Martin had preceded me by a few days on his way to his new assignment as Commandant of the Medical Field Service School. While in the SGO he had left a strong recommendation with the SG and the Chief of Education and Training, as previously mentioned, that an officer be selected to send to one of the University Programs in Hospital Administration, get graduate degree, and start a program for the Army.
Lucky me. I flew in at just the time Miss Carry had been called on to winnow the names of candidates for a one-year in- residence course at Northwestern University at it's downtown campus on Lakeshore Drive in Chicago.
Dr. Malcom T. MacEarchern, M.D., Executive Director of the American College of Surgeons had started the program some three years previously. It was one of seven university programs in existence at that time.
Dr. MacEachern has been called "the Father of Modern Hospital Administration" because voluntary hospital standards had been started by the American College of Surgeons in their hospital standardization for approval for surgical residencies. "Dr. Mack" was a Scotsman by way of Canada. His book became the "bible" of hospital administration.
So much for this. Miss Ann, says "Tommy, how'd you like to go to school for a year in Chicago and get a Master's Degree in Hospital Administration, then go down to San Antonio and start a course for the Army?" My reply was short and to the point. "Great"!
Aside from the sheer chance of timing, the criteria for selection were essentially: (1) selectee must have a degree and be eligible for graduate school, (2) presumably have sufficient rank to be director of a school program at the Medical Field Service School (I was an 05 at the time), (3) desirably have teaching experience ( I had been an Instructor in the University of Texas College of Pharmacy) (4) conveniently available for a year of detached service (I was in the pipeline and unassigned).
I spent a full calendar year at Northwestern University beginning in Feb. 1946, for the spring semester, summer school, and the fall terms, graduating in Feb. 1947. I was given constructive credit for the required one year of residency, presented my thesis, and was awarded the MSHA degree.
The Relationship
A flash back is here in order. A miserably cold and snowy early morning hour
(0600) in Dijon, France in December 1944 is the time and place. Snow had piled
up in drifts during the night, some fanny deep to a tall Indian.
I was duty officer in the Medical Section of SOLOC (Southern Line of Communications which was the logistical support command for L.G. Alexander Patch's Army Corps which had landed at Marseille. This was the diversionary tactic, peeled out of the Mediterranean Theater to give German forces a second front to worry about after the earlier Normandy invasion from Britain.
The phone rang in my apartment and jolted me out of deep slumber. The call was from the HQ Officer of the Day and he said, I have a BG Martin, Medical Corps here who has just driven in from Marseille on his way to Paris, what shall I tell him to do?
(Gen. Martin had flown into Marseille from Italy and got weathered in. Rather than layover for an indeterminate period, he had decided to push on to HQ ETO by an army sedan, loaned by the Base Section Transportation Officer.)
Having to respond to the needs of the moment, I asked the HQ Officer of the Day to have his driver drop him off at my quarters, an apartment which I shared with another Lieutenant Colonel. On his arrival, I had prepared him a hearty breakfast of fresh eggs, over easy, bacon, toast and coffee. I called the CQ and had the driver taken care of at the mess hall.
The previously related roles of the cited individuals in the concept and development of the program, have provided a back drop for this historical event. Their being brought into relationships that would cause their singular talents to contribute to the accomplishment of the mission required a catalyst: Tommy Richards, by pure happenstance and circumstances, became that catalyst. The difficult part comes now, that of weaving into the fabric the thread of thoughts, ideas and suggestions of others, before the accurate particulars of this process, known only to the writer, passes into oblivion with my demise. Here then, is my story passed on now to any reader interested in the genesis of the Army-Baylor Program in Health Care Administration.
My early army training and development in the period March 9, 1939 to March of 1942 was of little significance, nor had much if any bearing on this story. I had been at Walter Reed Army Medical Center about a year at the time Dr. Hardy Kemp hove into view for the second time in my life. I had numerous assigned duties such as: Officer in Charge of the Pharmacy Technicians School, Pharmacy Officer, Walter Reed General Hospital, (Asst Center Adjutant), Post Exchange Officer, and OIC, Hostess House. Lieutenant Glenn Smith had previously held several or all of these duties. Glenn had also been charged by the Surgeon General's Office with the writing of a Technical Manual for Pharmacy Technicians which for one reason or another he had never accomplished. It fell my lot to write this, published as TM 8-210. I only relate this event parenthetically because the experience in this pressurized trial by fire lent valuable early experience in later developing into army jargon the material of another Training Manual (TM) on Hospital Administration in the Army.
The Hardy Kemp experience at WRAMC was previously related, and is recalled again here only to fit it into the time sequence of events.
It was shortly thereafter that I was called on the carpet by COL Harry A. Bishop, MC Executive Officer, WRAMC (MG Shelley U. Marietta, Commander) and told, essentially as follows: Young man, we have been told that you have been down town advising or collaborating with civilians on matters pertaining to the U.S. Army Medical Department without authority and without clearance to do so. Do you know what we do with young officers who do this? (He didn't wait for my response, even if forthcoming) We transfer them out of the Washington area where they can't play politics. I was ordered to report to the 43rd General Hospital (Emory University Unit), then in training and staging at Camp Livingston, LA for shipment to North Africa. A quick and limited word on affiliated units as they existed prior to WWII, so that the reader has a better grasp, understanding, and appreciation of the further training the writer received as a very young officer after two years of rotating assignments at the then Station Hospital, Fort Sam Houston and WRAMC (about 1 1/2 years).
Most medical schools had on their staff and faculty, reservists who were to function in war time in the Table of Organization assignments of a General Hospital (a fourth echelon medical unit). Thus a Chief of Surgery brought colleagues in the surgical sub-specialties of orthopedics, ophthalmology, etc. the Chief of Medicine had assigned internists, a gastroenterologist, etc. There was a Radiologist and a Pathologist. This was before the days of the Anesthesiologist per se, and the Chief Nurse of the unit, in collaboration with surgeons, recruited Nurse Anesthetists among her Operating Room nurses and various other nurse specialists. These medical school professionals were then married up with an Army-provided cadre of administrative staff and an enlisted detachment of the various technical skills in the T/O of a general hospital. Most such units were attached to a state-side functioning hospital for varying degrees of on-the-job training (OJT) before being shipped overseas. (The 43rd General Hospital landed at Oran, North Africa and shortly started taking Fifth Army casualties out of Italy.)
After a relatively short time as Executive Officer of the 43rd General Hospital, I was brought from Oran to Algiers and temporary duty in the Surgeon's Office of Allied Force Headquarters. Then, back in Oran, AF HQ established a Communications Zone Headquarters and I was assigned there as Chief of Personnel for the Surgeon, Colonel Charles Shook. Because we were a relatively small headquarters, it fell my lot to have additional duties as Medical Records Officer and Evacuation Officer; coordinating shipment back to the U.S. Zone of Interior (ZI) of casualties by air evacuation or hospital ship who had been 'boarded' as no longer capable of performing military duties in the Theater of Operations.
This is recounted only because of an interesting development that evolved from necessity, and the exigencies of war time in this, the first Theater of Operations of WWII.
Our Medical Department replacement personnel were, of course, received in the Replacement Depot along with those of the combat arms, and other technical service offices, signal, quartermaster, etc. But we had a problem peculiar to medical officers. We had little indication of relative skill levels within the military occupational specialty of a surgeon, let us say, (MOS 3150) or an internist (MOS 3139). There were times when available replacements and Table of Organization (TO) or Table of Distribution (TD) did not match by MOS and mal-assignments were at least temporarily necessary. A first year resident in ophthalmology might not be happy fulfilling a general duty (MOS 3100) requirement, but 'needs of the service. must always over-ride personal fulfillment when push comes to shove. Only the immature fail in this understanding.
One day I got a list of new arrivals at the repple depot and noticed a Lt Col Edwin G. Faber MC, MOS 3139, listed among the names. He was about 50 years old and was a Fellow of the American College of Physicians from Tyler, Texas, I was to learn. I thought to myself, now here's a physician of exceptional qualifications, we need to review his needs more closely.
I called the depot and asked if they could get him in for interview the following day. He was short, rotund, completely bald, and of a thoroughly enjoyable personality. Besides, he had stashed a bottle of House of Lords Scotch in his barracks bag and had brought it into Oran with him.
Over a few scotches that night and dinner at the COMZNATOUSA (North African Theater of Operations, U.S. Army) officers mess I braced him with my problem of skill level differentiation for assignment purposes out of the replacement depot. We jaw-boned the problem considerably and out of this in depth discussion came four levels of prior training that were felt to be as predictive as possible of how well qualified a man should be to meet the demands of the unit assignments to be filled in the echelonment of medical units from the most forward aid station through clearing station, mobile army surgical hospital or evacuation hospital in the combat zone to station or general hospitals in the communication zone.
In screening a medical officer's skill level we would thereafter use A, B, C, or D as a prefix to his NOS. An A prefix would be the highest qualified. We wouldn't expect to get this latter type person through the depot system. He would be the older, board certified, long-experienced, medical school professor level physician who had been, or was qualified to be, a medical school professor and department head in his specialty. Assignment of this prefix would normally be done by the Surgeon General's consultant in that specialty through the Chief of Professional Services. Thus A3l50's (general surgery) would only be Chiefs of Surgery in general hospitals, consultants, etc.
The B prefix was reserved for those who were board certified, the C for those who had completed a residency in his specialty but had not yet completed his boards. The D would be assigned to those who had some training in a residency, but had not yet completed the prerequisite hospital program.
This problem and our proposed solution was duly reported approved by Colonel Shook, and described by me in the Essential Technical Medical Data Report (ETMD) made monthly to the Surgeon General by major command surgeons. I was responsible for the assembly and forwarding of this report by the Surgeon, COMZ Natousa.
I was later (some two years) to use the prefixes for MOS's as Chief of Personnel in reassignment and redeployment of medical troops out of the Theater Surgeon's office in Europe after VE day.
Just before Xmas of 1945, after 2 1/2 years overseas, I reported to the Surgeon General's Office for Z I reassignment, and, as previously described, was stationed on detached service for a year at the Chicago Campus of Northwestern University. Here I completed academic requirements for a Master of Science Degree in Hospital Administration (now broadened to Health Care Administration ).
In February of 1947 I was then assigned, to MFSS to initiate a program in hospital administration for the Army. I suppose, in retrospect, I was lucky and the breaks all came my way. On arrival at MFSS I found COL Abner Zehm, MC, had just been reassigned from the position of Director, Department of Administration to command William Beaumont General Hospital in El Paso. General Martin, no doubt remembering the cold morning and hot coffee in southern France, and knowing I was coming, saved the job for me. Traditionally all department heads at the school had been medical officers. I became the first MSC to head a faculty department. As a Lieutenant Colonel, I was at a slight disadvantage when all other department heads were senior colonels, Medical Corps. So at Faculty Board meetings I felt it the wiser part of discretion mostly "to be seen and not heard."
Here I was with an assigned mission, but no resources, unless I could squeeze them from other commitments. The instructors in the department taught or 'instructed' from a 'Program of Instruction" (POI) for basic and advanced courses for officers as well as certain enlisted technician courses. These programs were all well established and had been taught many times so that they were pretty well "routinized as to resource lectures and "best methods instructing. The old tried and true explanation, demonstration and participation had been employed many, many times.
But "administering" a hospital? Some kind of transition in thinking was essential. It was more education than training and this was not the army way. My own concept of training per se, has always been that it's objective is to develop a conditioned response" to a given situation. An ingrained set of reactions to a likely circumstance, drilled into the individual and through him, his unit response through many, many "exercises or dry runs. On the other hand, education is the process whereby a student is provided selected information to be sure, but then his reason and judgment is challenged in response to the unforeseen.
My challenge was to draw up a curriculum" or POI that would embrace subjects of greatest cogency and validity to the needs of the top hospital executives. These subjects then had to be described, references listed, allocation of classroom time made, and teachers recruited. General Martin and I were well aware that the first class, or classes would provide valuable experience to be critiqued and used in remolding subsequent efforts in shaping an improved course of instruction. Thus it was that we encouraged those selecting the first class of students to send experienced officers to the course. We wanted to present the course, then 'pick their brains' to evaluate the extent to which they felt the subject essential, the content valid, and the time allocated reasonably sufficient.
My own formalized curriculum at Northwestern University had, of course, been designed primarily to develop hospital executives or administrators for the civilian community hospital. It was up to me to pick, choose, and correlate subject matter from what Dr. Malcolm T. McEachern (the acclaimed father of modern hospital administration) had thought essential to his program and refine it, and redirect it to be suitable to the military setting.
Consider for the moment, the matter of funding. Historically the civilian hospital field was dominated in those days by the voluntary nonprofit institution. These, in turn, were largely church sponsored. Thus fund raising in the community was a large problem and appropriately needed curriculum coverage as to methods and techniques. And of course, religion in the hospital. Boards of Trustees and Medical Staff organization and relationships drew considerable attention, rightfully so. It seemed to me that as I began to sort out subject matter, much of the teaching I had been exposed to was "sorted out" instead of "sorted in."
But there were areas of need that were in great commonality. As an example, the lay person needs some grasp of medical terminology so that he can understand the physician to some degree and relate patient needs in some measure to diagnostic terminology, while civilian law did not apply in the military setting there certainly were legal aspects that needed addressing. A hospital executive at any level, whether department head or the top administrator, needs basic knowledge of accounting and statistics, or such was my conviction, and so on and so forth.
It had been decided by the gurus in the training in the SGO that 12 weeks would be devoted to the initial course. While this allocation of time was somewhat empirical and arbitrary, it did fix and provide the rigid, structured and omnipotent element of time. Now all I had to do was to break out clock hour time allocations to selected subjects. This too was judgmental, empirical, and in great measure arbitrary. I knew that "down the road" adjustments would have to be made.
Once I had the subjects on paper for a "program," each one needed a short description of what was to be embraced -a short list of parameters, if you will, of sub-titles embraced by the titled subject.
When it came to law, the hospital physical plant and as mentioned above, these were all new subjects to be taught that had never before been envisioned in an Army Medical Department Program of Instruction.
Now to find and gather faculty. Sanitary engineers were logical persons to teach requirements of the hospital in terms of floor space and layout as well as architectural and structural design. As previously mentioned, General Martin had seen Evac. and MASH hospitals convert school buildings and churches or other public facility buildings to fulfill the care needs of sick and injured, mostly on the basis of improvisation.
When it came to medical matters and the law, an MSC with an LLB was found who could sift and sort matters of the Federal Tort Claims act and other Legislated Federal and State-level penal and civil statutes germane to medical practice and patient care.
Another area that had never previously considered was medical terminology. It was not too difficult to prevail on the Director of the Department of Medicine and Surgery to provide a young physician who would teach our lay administrators to understand what "doctor talk" is all about, medical etymology, if you will.
The decision was made by the training authorities in TSGO that the first class would be for 12 weeks duration would begin the first week of November 1947. Now we had something finite and concrete and could start turning plans, into action the "execution phase" had to follow.
We had to go civil service and got a space set up for a civilian instructor in accounting and statistics. In retrospect I suppose we could have called on the finance Department to detail an officer to teach these subjects but it didn't occur to me at the time to reach outside Medical Department Military Occupation Specialties for staff, in any event we employed an ex school teacher by the name of Rose Lee Thoms to teach the essential of double entry bookkeeping, elements of cost accounting and the rudiments of statistical method. A graduate degreed ANC officer was found to teach this most significant aspect of inpatient care.
The first class was made up of experienced officers in the Medical Department who had performed in all of the MOS's then found in TO&E's or TD's (Tables of Organization and Tables of Distribution) for hospitals, e.g., supply, medical records, personnel, registrar, food service etc. (This was before the Women's Medical Specialty Corps provided Dietitians in a commissioned MOS).
There was at that time, 1947, in the U.S. Army an arrangement with the University of Maryland whereby Armed Forces personnel could take correspondence courses for college credits. The military agency through which this was administered was the United States Armed Forces Institute or USAFI. We encouraged our officers in our earlier courses to enroll with USAFI in those several courses where textbook coverage in USAFI paralleled the subject matter in our own Program of Instruction so that they could successfully complete examinations at a later time and thus receive transferable college credits at the University of Maryland. This was an optional voluntary opportunity for the educational-minded officer. Some saw the handwriting on the wall" that self improvement in educational pursuits would enhance their credentials to be weighed by future promotional boards. No records were kept on the number who pursued this recourse since it was extrinsic to our primary mission.
It occurred to me in the spring of '48, if Maryland could award correspondence course credits to enrollees through USAFI, then why couldn't we get local colleges to do the same thing through local matriculation? In pursuit of this thought, I approach St Mary's University, Trinity University and Incarnate Word College with a proposal of some such arrangement, the details to be worked out to mutual satisfaction. At this endeavor I was completely thwarted. Either my talents of suasion and salesmanship were sorely lacking, or my conceptual thoughts of a military-civilian partnership in education in health care administration were falling on fallow ground. In any event, the local college authorities with whom I met were 'just not interested in devoting any part of their resources toward such an unheard-of endeavor. The subject matter I had presented was in a field of education utterly foreign to them and just didn't spark their fire of academic adventurism. I suppose if I were standing in their shoes I could better understand that their reticence to dabble with the military was incompatible with their community concerns for "education" in algebra and history and music and Shakespeare.
Monday morning quarter backing, or the 20/20 vision of hindsight seemingly always provides one with the smug know-it-all satisfaction of the savant. I should have recognized that my avenue of approach to St Mary's and Trinity faculties should have been through the ROTC (Reserve Officers Training Corps) units and the Professor of Military Science & Tactics (PMS&T). Strange that here some 45 years later I should have acquired the wisdom for me to see that this might have worked!
It became quickly evident after the first course was presented that we were trying to cram too much material into too compacted a time frame. The student critique was universal on this point, less critical of subject matter, but they were in unison that we were just "carrying them too fast." To cut back on subject matter and subjects, or to stretch out the time were the only two obvious alternatives in solution of our problem of the cram-school dilemma.
Once the "pipeline" is flowing with it's content, whether an item of supply or the flow of personnel, it seems that in the military it takes abrupt and sometimes a disruptive decision to turn the spigot and alter the input. It is so much simpler to "go with the flow". Another twelve-week class was already in the pipeline for fiscal year (FY 48 so we had a second group of helpers come in to assist in molding and shaping a course to meet military needs. In FY'48, General Martin with my urging and the student post-course-surveys to support my contentions, prevailed with TSGO to stretch the next two courses out to 20 weeks. This gave us two more months to soften the impact of the "ton of material" in which we were trying to get students to intellectually invest. It has always been my concept that an "educator, should try, or rather the process of education should be an effort to condense knowledge into a time frame and present it to the student in assailable form that would other wise take him/her a much longer period of time to acquire by the trial and error of experience. Further, while this "academic process" is going on in the classroom or laboratory, the student should be somehow stimulated to develop the acquisitive mind that will continue to thirst for knowledge beyond the immediate class, or course of instruction. Only by providing this stimulus toward the pursuit of knowledge can the teacher, instructor or educator have fulfilled his role and ultimate success in the educational process. Many students grasp a diploma and emerge from their academic cocoon into the real world under the misguided belief that they are now possessors of that magic potion that equips them to cope. Little do they sometimes realize that their true education has just begun.
Two classes of twenty weeks each were approved and graduated before we could again rely on student critiques to justify still further expansion of time. Increasing the course to thirty-nine weeks seemed essential to fulfill the hope of developing "well rounded, broadly "educated" young officers being molded into the health care executives of the future for the Army Medical Department.
By the time the twenty-week program was approved, in FY 48, the Chief of the Army Nurse Corps had concluded, and the Surgeon General approved that nurses should be included in the program. CPT Ann Wiotezak, ANC, had been assigned to our Department of Administration in August of 1947 and the inclusion of this largest and most essential element of the medical care team was duly formalized and embraced. They afforded a welcome and component with the legislative establishment of the Medical Service Corps and Women Medical Specialty Corp in 1947 these Corps had embraced other essential MOS's to the medical care team and became duly represented in student body.
Conservation of physician time by attending to all of his resource needs for direct patient care has always been the goal. Only the physician has been qualified through the long and mailsome process of learning the art and science of medicine to head the healthcare team. His skills in direct patient care decisions should be frittered away on the mundane and routine matters attendant to other aspects of patient care. Thus the "administrator" was to be an "adjunctive" person to the commander of the medical unit directly involved in patient care. The physician should never be replaced or displaced from his vital role of decision making when patient care is at stake. Enter Baylor University.
It was a fateful day that I stopped by the bar at the Officers Club at Ft Sam Houston on my way home from the office to imbibe a toddy for the body. I had walked to work that morning, a Friday in October of '48, as I recall, because of a dead battery. Both walking to work and stopping by the club were unusual events for me, neither a part of my daily routine.
In any event, I was sitting at the bar in the Raven Room imbibing at about l715 hours when a ruddy faced gentleman in a civilian suit entered and mounted a bar stool across the corner of the bar from me, maybe four feet away. Even in the dim light of the bar-room, I recognized Dr. Hardy Kemp M.D. from our two previous encounters at the University of Texas in '33 and AMC HQ in '43).
Dust my britches, but don't I know you from somewhere? I questioned. I'm Hardy Kemp he replied, and you must be Tommy Richards! We reminisced a bit until my curiosity led to ask what in the world he was doing here at Ft Sam.
He explained that he was Dean of the Graduate School at Baylor University School of Medicine in Houston. He was here consulting on matters pertaining to an arrangement whereby residents in the various medical specialties were enrolled with the medical school as they began their residency. Then, by completing a research project during the course of their training and presenting a thesis, they were awarded a Master of Science Degree in the specialty by Baylor as they graduated. This served the purpose of enhancing research in medicine, encouraging physicians in the military to be research-minded and better qualified them for their written and oral boards for certification in their specialty by the certifying boards.
Then came my turn to fill him in on what my current duties were. I explained that I was the Director of the Department of Administration and that one of my prime missions was to start a course in hospital administration for the army. I told him about our efforts to use the USAFI mechanism for under graduate college credits and my disappointing efforts to get local colleges to work out details of college credits for work completed by our students.
At some point in our discussion Hardy says, I believe I can talk our people at Baylor to cooperate with you on this. Wonderful, I responded, When do you suppose you could let me know? I'll talk to our folks when I get back to Houston and call you by the end of next week.
As far as my friend Hardy and I were concerned, it was a done deal. All we had to do was sell it to others. Little did we realize the many pitfalls and obstacles that lay ahead!
True to his word, Dr. Kemp called the following week and while not completely negative, he had both good news and bad. The good news was that the Dean of the Baylor College of Medicine thought it a good idea to try and work out an academic affiliation in hospital administration; he didn't think it was a compatible discipline with the medical curriculum. He felt it more appropriate for the Waco campus of Baylor, possibly the School of Business.
The main thrust of this second step was that the Dean was positive, a warm support rather than a "cold-water negative. Then Hardy continued that he had discussed the matter with Dean Wilbur T. Gooch, Ph.D., at Baylor and would arrange for me to present the whole concept to him and the college deans, of the various schools at my earliest convenience. Great! I thought, at least we are still moving forward.
Recall now the earlier reference to Harry Panhorst. He was my ace-in-the-hole. A slight repetition seems in order. Harry was Assistant Director of the Washington University Program in Hospital Administration located at Barnes Hospital, the Medical School teaching hospital in St Louis. Harry was on two weeks of active duty training and had been assigned for that period to us in the Dept, of Administration at the Medical Field Service School. Harry was the personification of the complete Army officer. At 6'4' in height, he was athletic, handsome, poised, and well coordinated with grace in his movements. His voice was deep and resonant. He spoke with conviction and a vocabulary of well-chosen words.
To the convened Graduate School Faculty Board in Waco I presented the concept. I would draft a college curriculum of courses to be taught. We would then submit this with a roster of our proposed faculty, together with their individual curriculum vitae." Baylor would then tender letters of appointment to each an unremunerated faculty position to teach the proposed courses.
Harry Panhorst then followed me with a glowing report of how academically sound our program was. As an Assistant Director of a university program he described their own program at Washington University and enumerated the other universities that had such programs. There were only seven universities in 1950 that had such curricula. They were located at such prestigious universities as Harvard, Yale, Columbia, Northwestern, Chicago, Washington, and Dartmouth College. This was a pretty heady group of academic institutions for Baylor to be joining in an attempt to formalize health care as a recognized discipline to embrace for academic direction and support.
Preeminent among these courses at that time were those of Northwestern and Chicago, headed respectively by Malcolm T. MacEachern, M.D. and Dr. Bachmeyer. Each had published books on Hospital Administration, and thus held some legitimate claim to fame in the field. In addition, Dr. MacEachern, a lovable old Scotsman by way of Canada, was and, had been for years, Executive Director of the American College of Surgeons. In this capacity he had conceived and fostered the hospital standardization rules by which teaching hospitals could voluntarily qualify for approval as an "accredited" institution for general surgery residencies.
Because of his visionary activities in upgrading institutional care through voluntary standards of excellence, "Dr. Mac" was fondly known by his peers as the "Father of Modern Hospital Standardization." The Army had chosen his course to send its first post WWII student to for graduate education. I quite naturally became "his fair haired boy" to receive his enthusiastic endorsement and considerably prestigious support in all matters academic. I called Dr. Mac on the phone and asked him to write a letter to Dean Wilbur T. Gooch, Ph.D., Dean of the Graduate School at Baylor University and lend his weighty endorsement to our efforts. I never received a copy of any communication between the two, but I am certain in my own mind that Dr. Mac did communicate his ringing endorsement of our efforts to Baylor. Dean Gooch thus had heard from both Washington and Northwestern Universities in support of our project to bring Army education in some degree under advisory aegis of academia.
After all, we had proposed that Baylor faculty would be invited as guest lecturers in selected courses of our program. This infusion of Baylor teaching talent had to give them some semblance of feeling closely akin to the program.
After Panhorst and I left the Waco Campus we could only fret and wait. About two weeks later Gen. Martin received a letter from Dean Gooch that on behalf of the Baylor president he was happy to announce that Baylor, subject to approval by the Southern Council of Education, would be happy to proceed with their end of the affiliation process as proposed. My anxiety-ridden days of waiting were over. We could now hunker down, get the shoulder to the wheel and formalize what thus far had only been a concept.
I drafted a letter for the Commandant's signature to the Surgeon General requesting approval for the affiliation. I suppose I was naive enough to think that there was no question but what the Army would grasp this opportunity to achieve academic credit for courses it was to teach anyhow. After all, the Army had placed great emphasis on higher education by then, (1949) sending hundreds of officers from all Corps to the college campuses to get advanced degrees in numerous disciplines. Little did I know the pitfalls and pratfalls that lay ahead.
In about six weeks "our" letter came back, endorsed "Disapproved. How could we tell Baylor that all our planning and efforts were for naught? Well, "the best laid plans of mice and men.
When I got the letter routed to me from "upstairs," I'm sure my mouth must have fallen agape. I was astounded at the-stupidity of the higher-ups in the chain of command who were so unmindful of the advantages of grasping this opportunity that had come the Army's way by chance and circumstance! Strange how we rail at those who disagree with us at times.
I took the letter in hand and literally bounded in to see General Martin. He could quickly see my agitation and knew its cause. He too was p.o.d, but in his maturity, the outward evidence was less visible. Where I was fighting mad and literally fuming, he was cool as a cucumber and much more calm in his cerebral approach toward what to do next.
Suddenly his face lit up and he picked up the phone. Adele, said to his secretary, put a call through to Arthur Trudeau. I knew there was a LTG Trudeau, but all these years I thought he was Deputy Chief of Staff, Operations and Training, Department of the Army. Only recently did I discover that he was then Commandant of the Army War College at Carlisle Barracks, PA.
Anyhow, General Martin told him he had this idea of affiliating some courses in one of our Programs of Instruction with Baylor University for college credit and that it had been turned down. He asked if Art could reopen the matter and maybe get a favorable response. Gen Trudeau asked for a copy of the letter and in due time called Gen Martin and suggested that he resubmit the letter for reconsideration. Its approval had been greased! I never did know who talked to whom upstairs, but final approval did come through and gave cause for great rejoicing and jubilation.
Constructing a Curriculum.
Before we could start the very first class, Reiterate, it had been necessary
for me to write an Army style Program of Instruction (POI). This bible of the
classroom listed each subject to be taught in the course and a description of
purpose and content reduced to a descriptive paragraph.
Now it became necessary to rework this POI into a college catalogue quarter hour credit type of course description with an allocation of didactic hours of fifty minutes each.
Each didactic hour was then supported by a lesson plan prepared by the instructor, a lecture, demonstration, field trip, case study or whatever.
In vogue in academic circles at that time was the so-called Harvard case study method of teaching. Instructors were encouraged to adjust their lesson plans to this mode to the extent possible.
It had always been my personal educational philosophy that the officer student was the raw product the Army had selected and entrusted to us on the faculty to groom, and turn back to duty as an improved officer. It was not for us to try to screen students and label them as underachievers or academically inept. There are rote students who can cite material presented to them in class, but lack the reasoning power and judgment to apply matter-of-fact knowledge in the solving of every day problems, or in the goal- directed planning which prevents many problems from arising in the first place (these people I call 'educated idiots') .It is the judgment factor in the final analysis that is most predictive of a student's success or failure in the crucible of real life.
And so it was that in furtherance of this developmental goal that we reserved a two-week 'practicum' at the conclusion of the didactic portion of the course for a community hospital problem- solving stint. I picked 15 civilian hospitals to which we sent two students each for this feature of the course. I had visited each hospital and secured the Administrator's agreement to cooperate in assigning projects to students. Each students was to study one or more problems or potential problem areas, as time would allow, and "write it up' for presentation to the administrator; and with his concurrence, present it to the rest of his fellow students on return to the classroom. This was sort of the 'icing on the cake' where the student officer could exhibit the degree to which his/her analytical judgment in problem solving had been developed or sharpened.
The AUPHA.
The seven Universities and College previously mentioned had bonded together in
an Association of University Programs in Hospital Administration (AUPHA) and
had set up some standards by which the adequacy or excellence of such programs
established at other educational institutions were in the future to be judged.
We applied for accreditation in 1950 and at a meeting of the Association in Chicago in the spring of that year our accreditation was voted down. Col Byron Steger, MC (later MG) was then Chief of Education and Training in the Surgeon General's Office and had attended with me to represent the Army.
While our accreditation was staunchly sponsored and supported by Dr. Frank Bradley of Washington University and Dr. MacEachern of Northwestern, the other five universities just didn't know enough about us.
Byron and I commiserated with each other after the meeting adjourned and discussed our next move. I suggested to Bryon if he would support an increase in our funding, we'd invite some of those "peckerwoods" as guest lecturers in our program so they could "look us over. I had sort of sniffed out the opposition and found that the most vocal agin 'ems were Ray Brown (Bachmeyers' assistant) of Chicago and Jim Hamilton of Dartmouth (the latter later moved to the University of Minnesota when funding became a problem at Dartmouth because of the high per capita cost and low tuition revenue which was the nature of all those courses at that time).
For the next class we included them as guest lecturers, along with Dr. Lembke of Yale. With Dr. Mac and Dr. Bradley already aboard we now had a majority vote in the AUPHA! With on-site orientation to our program, and all these Course Directors becoming a part of it, we were voted in the following year. (Funny how things suddenly get better when you're a part of it!)
There was one matter that has always kind of haunted me. This was the fact that at that time we had no funding for the wining and dining of these people. We paid them a token equivalent of round- trip plane fare plus one-hundred-dollars a day stipend, but their entertainment and it's cost fell to my personal lot. For this purpose, I estimate that I spent out of pocket about $1200 in the 1951 -52 academic year which in that period wasn't hay. Consider that at 7% interest, compounded daily, a dollar doubles in value every seven years. By now that $1200 would be a tidy little sum. But then, I console myself, what the hell, we might not have had a degree program for my fellow officers either! And in the end, as Lord Keynes said, we're all dead anyhow.
Other Contributors to the Mission.
The foregoing story would not be compete without giving due credit to the
supporting cast - those numerous officers who unstintingly gave their best
efforts as teaching staff. During my five and one half years at MFSS those who
came and went were too numerous for me to recall accurately.
Early in our staffing, graduate degrees were not important because we had no ideas then of faculty appointments by Baylor. Then advanced degrees became important. When I arrived at MFSS in February of 1947, Roy Bryan, Chris Hoover, Jack Walden, John Zurcher, and Lou Sanders made up the teaching staff. We had no one to teach the subjects of accounting and statistics so we turned to civil service employment and were fortunate to recruit a female with a Masters Degree in Education with a minor in these two subjects. Rose Lee Thoms previously mentioned, was to stay on through numerous classes, and became a fixture until she was ultimately replaced by an officer with suitable teaching qualifications and a graduate degree.
Bob Floyd was an active duty reservist who had a Master's Degree in Hospital Administration from Columbia. He was assigned to us before the affiliation was completed. We needed an attorney to teach the legal aspects of medical care and were fortunate in getting Major Jack Haggerty, He was later, replaced by MAJ Woody Woodruff.
In 1949, Gordon McCleary was the second graduate of the Northwestern University program and came to us to strengthen our graduate level teaching staff to satisfy academia and Baylor. Howard Scroggs completed Northwestern in 1950 and also joined us.
Walter Beeson was another outstanding officer who strengthened our teaching staff in 1950. By then we could begin to select exceptionally qualified officers from among our own graduates. Among these were such stalwarts as Glenn Irving, Sam Edwards, and Tony DiMattia.
By June of 1952, we had graduated our second 39-week class and our affiliation seemed to be working smoothly. After 5 1/2 stressful but pleasant years, and with a sense of achievement, it was re-assignment time for me.
Gen. Martin had prevailed on the staff in the SGO to select me I as the second MSC to attend the U.S. Army War College. This was, of course a distinct honor. Barney Aabel, the second Chief of the Medical Service Corps, had attended the 51-52 class.
From Carlisle Barracks I was assigned to the Surgeon's Office of the Korean Communications Zone where I arrived for duty three weeks before the Armistice was signed, but in time to write the Medical Annex to the K Com Z Operations Plan for the Prisoner of War Exchange. After the wrap-up in Korea, it was back to TSGO as Chief of Training Doctrine Branch, Education and Training Division, SGO.
After about a year in that assignment. Col. Byron Steger, MC (later MG) was by then Chief of Personnel in TGGO approached me on the putting green at the Army Navy Country Club one Saturday morning. He asked if I was interested in assignment to Brooke General Hospital as Executive Officer. He knew the answer. I was overjoyed and felt rewarded again by a choice assignment. Soon after arriving at Brooke. I was called by Colonel Steger to ask if I was interested in going to the University of Iowa to work on a Doctor of Philosophy Degree. Another potential honor had been made available to me.
But I had moved five times in the brief span of about three years. The timing was such that I was in a condition of what today is called "burn out". I rationalized that a Ph.D. was, aside from the prestige factor only of value in one of two pursuits, teaching or research. I recommended that Howard Scroggs be given the opportunity, which he took. The earlier recommendation I had made for this action to be taken, thus when implemented, I let slip away. I had the secret hope that I could go the following year, but it was not meant to be.
At Brooke I became a preceptor for healthcare administration graduates and thoroughly enjoyed Saturday morning sessions of give and take with bright your officers coping with the myriad problem- solving situations that arise in the day-to-day administration of a large teaching hospital.
Disaster planning for hospitals was recognized as a problem area that needed considerable attention. Such a plan, with simulated drills, had become a requirement in the Joint Commission on Accreditation of the Hospitals. I wrote the plan for Brooke which was approved and adopted by the Surgeon General as "the guide" for other U.S. Army hospitals to adopt and modify to local conditions. Years before, I had picked up on hospital disaster planning as my "thing." Several of the University Program Directors had invited me as a guest lecturer in their programs back in the 1950-51 period so that my thoughts on the subject had been well aired, discussed, and reshaped. Recall that in those days radioactive decontamination was a big factor in atomic casualty care.
My premature retirement was soon to be realized. A broken promise that precipitated turbulence in my private life was the cause. A sad aspect of military life is the nomadic existence it imposes on personnel, often, I am convinced, with little rhyme or reason. In my instance it was, I am convinced, caprice. There were 05's in MSC assignments and "career management" in TSGO who needed 06 vacancies for promotion. Couple this with another natural consequence of military service, and I became the "odd man out."
As hospital commanders change, so are some of the favored staff members. This is a natural consequence of interpersonal relationships. I had served compatibly under three CG's. I had become a short timer, but a new CG was assigned in the fall of '59.
Not to worry, I was told. For the purpose of continuity I would remain at least another year. I had just bought the first house my wife and I had ever owned and we had moved in. Wonderful, I thought. We could enjoy our new home for a year, serve one more tour elsewhere and than plan for retirement, but this again was not to be. My incumbent CG (MG Clement St John) was reassigned to Walter Reed and asked if I'd like to go there as his "XO," Chief of Administrative Services or Chief of Staff for Administrative Services, or whatever the position is now called. Again the conflict between family and duty assignment were in sharp focus. This age old factor complicating military life places an officer on the emotional rack of hard decision-making. I declined the invitation to go, partially from selfish motives and partially because I knew I would displace and discommode another officer. (When I came to Brooke, the XO job was occupied by a more junior officer who knew he was temporary, so I had not felt this compunction, and the CG wanted me assigned.)
I placed the case of my peculiar circumstances to the Brooke Army Medical Center Commander for another assignment within the command for just a brief period to settle in my newly acquired "retirement home." But there seemed to be no alternative but to accept reassignment as XO to the First Army Medical Section at Governor's Island New York, or retire. With heavy heart I chose the latter. Now the top 05 on the promotion list had a vacancy to which he could be promoted! He had been in a key spot to assure that another homesteader in San Antonio had been retired to his personal benefit. This is the reality of service. It was my choice to stack arms" and move on from military service to private life.
Other Department Directors.
It would be thoughtless and unkind of me not to mention two MSC Colonels who
were assigned, each for short periods of time, as Directors of the Department
of Administration at the old MFSS during my five and a half years there. Anyone
experienced in personnel assignments in the early years of 06-authorized
promotions recognizes that T/D vacancies did not exist for many of that rank. I
occupied one T/D position as an 05. So any dim wit could see that I should
anticipate a new boss.
With all due deference to Joe Martin, he called me in in each instance and asked how I would react to such assignees. It isn't every commander who shows this much concern for his subordinates.
Colonel Eddie Wons. COL Wons had been IG at BAMC as an 05 and was surplus in grade when promoted to 06. He was one of the finest old gentlemen I have ever known. We got along beautifully. He was not the kind of person disposed to "throw his weight around" as some people are disposed to do. He was devoted to education and training and because he recognized my passion for this for MSCs, he backed me to the hilt. He only had to serve the retirement and then intended to "stack arms - I was sort of sorry to see him go!
Colonel Dale Thompson. Those familiar with post WWII integration realize that the Medical Service Corps, created legislatively in 1947, brought in many top officers from other Corps. There's no mystery about it. They were offered a Regular Army Majority when their own Corps, be it AG, OM, Ord, Sig., or one of the combat arms, could offer them an 02 or 03 RA grade. By law, Eddie Wons and I had been limited to the grade of Captain prior and during the war. We didn t have field grades in the Regular Army authorized! Bill Hamrick and Dale Thompson happened to have been AG's.
Dale had been the Adjutant General of the Middle Eastern Theater during WWII, no mean achievement for any A.G. He was a very fine officer of his corps, I'm certain. His complaint to me once was that the other colonels at MFSS didn't "accept" him. He in effect, was a high ranking outsider.
There is little doubt that the feeling of alienation influenced his behavior toward his subordinates, particularly his assistant whom he had displaced.
Undoubtedly I felt a deep seated resentment toward these integrees who came from other corps, with no Medical Department experience or "conditioning." It has rightfully been said that if you can't subordinate, you can't command; or, if you can't follow, you can't lead, or whatever. Anyhow, I tried in all good conscience to subordinate and be a "good soldier" with Dale Thompson as my rating officer. But we clashed. He was a "take charge" kind of guy. Trouble was he didn't know what he was taking charge of! Or at least this was my disdainful solace when we clashed. I have often wondered what his efficiency ratings were like, but I didn't worry much knowing that Joe Martin would assure that no unjustified gaffe took place.
Without the accuracy of a written record before me, I don't remember the dates or time span involved, but he too moved on after one and one half years reassignment to Walter Reed Army Medical Center which by then had upgraded an MSC spot at headquarters to accommodate him.
In no way would I degrade or demean Dale Thompson or detract from his being an effective and capable officer. But the chemistry wasn't there; the circumstances of his rank and training were inconsistent with his assignment, and I am certain that all this colored our relationship to no great discredit to either. Trouble was, others who didn't have all the insight and understanding above probably thought we were more like two tom cats with their tails tied together, thrown over a barbed wire fence.
The Health Care Industry in Turmoil
The years of 1993-94 will, by future generations, be recognized as hallmark
years in the healthcare industry. Politicians are making it the subject of
intense scrutiny with a view toward altered legal mandates. Espousal of
healthcare as a "civil right" or an "entitlement" are being
repeated in public forums to the point where many citizens are adopting the
view that this "inalienable right" is denied some; and therefore must
be provided universally at all cost. Some politicians with more blind ambition
for power than intellectual horsepower of insight and understanding are crowing
like Chanticleer, and healthcare as their "dung heap" from which to
crow. Erroneous data are being used to support misdirected invasions of
government into private lives. While the electorate is awash with much pure
hokum, just as is the North American Free Trade Agreement, it is hoped that
it's ultimate wisdom in our representative democracy will prevail to improve
rather than destroy what it has taken many years to evolve.
The future belongs to youth. We who have lived the past can only hope that the timeless institutions we have bequeathed will not be destroyed, but used as solid foundations for improvement by the present, and future technology that conserves and improves the lives of all mankind.
